Topic: Polycystic Ovarian Syndrome.
Etiology of the PCOS, Risk factors,clinical features, diagnosis, treatment and complications of the PCOS. The diagnosis is discussed according to clinical criteria. The investigations are discussed in details as well.
2. POLYCYSTIC
OVARIAN
SYNDROME
Aso called chronic ovarian
androgenism.
The diagnosis is made when
any 2 of the 3 are present:
1)Amenorrhea or irregular
menses
2)Signs of hirsutism
3)Polycystic ovaries on
ultrasound
5. SYMPTOMS OF THE PCOS
Insulin resistance
occurs in both lean
and obese patients
Acanthosis nigricans:
browning of skin folds
in intertriginous zones
(indicative of insulin
resistance)
Family history of DM
Average age 15-35
yr at presentation
In adolescents, wait
at least 1-2 yr to
make diagnosis
Abnormal/irregular
uterine bleeding,
hirsutism, infertility,
obesity, virilization
6.
7. POLYCYSTIC OVARY DIAGNOSIS
ROTTERDAM CRITERIA
2 of 3 required:
1)Oligomenorrhea/irregular
menses for 6 mo
2)Hyperandrogenism:
-clinical evidence – hirsutism
or male pattern alopecia or
-biochemical evidence –
raised free testosterone
3)Polycystic ovaries on U/S
Polycystic Ovary Showing “String of Pearls” Appearance
as Seen on Sonography.
8. INVESTIGATIONS
TRANSVAGINAL OR
TRANSABDOMINAL U/S
Polycystic-appearing
ovaries (“string of
pearls” – 12 or more
small follicles 2-9
mm, or increased
ovarian volume)
LABORATORY
Free testosterone will be
elevated secondary to the high
androgens. The high androgen
level and obesity lead to an
increase in estrogen formation
outside the ovary. This
stimulates LH secretion while
inhibiting FSH secretion,
leading to an LH to FSH ratio
of more than 3:1
INSULIN RESISTANCE OR
GLUCOSE TOLERANCE
Fasting glucose:insulin
ratio <4.5 is consistent
with insulin resistance
(U.S. units)
75 g OGTT yearly
(particularly if obese)
9. Enlarged ovary is pearly white, multiple cysts
are visible beneath the surface.
10. TREATMENT
Weight loss
Patients who are obese should be counseled to lose weight,
which will decrease the insulin resistance.
Lifestyle modifcation (decrease BMI, increase exercise) to decrease peripheral
estrone formation.
OCPs
Control the amounts of estrogen and progestin that are in the body.This both
controls the androgen levels and prevents endometrial hyperplasia.
This should be used only if the patient is not attempting pregnancy.
CLOMIPHENE
& METFORMIN
Should be used in patients who wish to
conceive.
12. CREDITS: This presentation template
was created by Slidesgo, including
icons by Flaticon, and infographics &
images by Freepik
THANKS
Please keep this slide for attribution
